Bottom Line:
The authors performed a thyroid function test and orbital computed tomography (CT) in all cases.Thyroid function was normal in all patients, CT showed an adhesion of the superior rectus muscle and superior oblique muscle in the first case and diffuse thickening of the superior rectus muscle and levator complex in the third case.CT showed no specific findings in the second or fourth cases.

ABSTRACTWe report four unusual cases of upper eyelid retraction following periorbital trauma. Four previously healthy patients were evaluated for unilateral upper eyelid retraction following periorbital trauma. A 31-year-old man (Case 1) and a 24-year-old man (Case 2) presented with left upper eyelid retraction which developed after blow-out fractures, a 44-year-old woman (Case 3) presented with left upper eyelid retraction secondary to a periorbital contusion that occurred one week prior, and a 56-year-old man (Case 4) presented with left upper eyelid retraction that developed 1 month after a lower canalicular laceration was sustained during a traffic accident. The authors performed a thyroid function test and orbital computed tomography (CT) in all cases. Thyroid function was normal in all patients, CT showed an adhesion of the superior rectus muscle and superior oblique muscle in the first case and diffuse thickening of the superior rectus muscle and levator complex in the third case. CT showed no specific findings in the second or fourth cases. Upper eyelid retraction due to superior complex adhesion can be considered one of the complications of periorbital trauma.

Figure 1: Case 1: (A) At his visit he showed mild swelling and bruising in the left eyelid, but no retraction was noted. (B) Left upper eyelid retraction developed one month after blow-out fracture repair. (C) CT scan showing a large left medial and inferior wall fracture and soft tissue incarceration. (D) One month after blow-out fracture repair, this CT scan revealed adhesion between the superior rectus and superior oblique muscles (arrow).

Mentions:
Case 1. A 31-year-old man presented with left periorbital swelling and diplopia after a blunt orbital trauma (Fig. 1A). The man reported being hit by a lump of iron at work the previous day. The patient complained of diplopia in the primary position, left gaze, and downgaze. Hertel exophthalmometry measured 17 mm OU. Initial orbital computed tomography (CT) showed a large left inferior and medial orbital wall fracture extending posteriorly (Fig. 1C), and soft tissue was found to be entrapped at the orbital floor fracture site. The patient underwent surgical repair of the medial and inferior orbital fractures. Incarcerated soft tissue was released from the fracture site and a 26×16×1 mm sized Medpor barrier sheet implant (Porex Surgical Products Group, Newnan, GA, U.S.A.) was placed over the defect. One month after surgery, the diplopia disappeared in the primary position but remained in downgaze, especially during adduction. In addition, we detected newly developed left upper eyelid retraction and lid lag on downgaze (Fig. 1B). Hertel exophthalmometry measurement was the same as before surgery. An orbital CT scan revealed adhesion between the superior rectus and superior oblique muscle (Fig. 1D). The patient was followed for 10 months and the left upper eyelid retraction persisted without improvement.

Figure 1: Case 1: (A) At his visit he showed mild swelling and bruising in the left eyelid, but no retraction was noted. (B) Left upper eyelid retraction developed one month after blow-out fracture repair. (C) CT scan showing a large left medial and inferior wall fracture and soft tissue incarceration. (D) One month after blow-out fracture repair, this CT scan revealed adhesion between the superior rectus and superior oblique muscles (arrow).

Mentions:
Case 1. A 31-year-old man presented with left periorbital swelling and diplopia after a blunt orbital trauma (Fig. 1A). The man reported being hit by a lump of iron at work the previous day. The patient complained of diplopia in the primary position, left gaze, and downgaze. Hertel exophthalmometry measured 17 mm OU. Initial orbital computed tomography (CT) showed a large left inferior and medial orbital wall fracture extending posteriorly (Fig. 1C), and soft tissue was found to be entrapped at the orbital floor fracture site. The patient underwent surgical repair of the medial and inferior orbital fractures. Incarcerated soft tissue was released from the fracture site and a 26×16×1 mm sized Medpor barrier sheet implant (Porex Surgical Products Group, Newnan, GA, U.S.A.) was placed over the defect. One month after surgery, the diplopia disappeared in the primary position but remained in downgaze, especially during adduction. In addition, we detected newly developed left upper eyelid retraction and lid lag on downgaze (Fig. 1B). Hertel exophthalmometry measurement was the same as before surgery. An orbital CT scan revealed adhesion between the superior rectus and superior oblique muscle (Fig. 1D). The patient was followed for 10 months and the left upper eyelid retraction persisted without improvement.

Bottom Line:
The authors performed a thyroid function test and orbital computed tomography (CT) in all cases.Thyroid function was normal in all patients, CT showed an adhesion of the superior rectus muscle and superior oblique muscle in the first case and diffuse thickening of the superior rectus muscle and levator complex in the third case.CT showed no specific findings in the second or fourth cases.

ABSTRACTWe report four unusual cases of upper eyelid retraction following periorbital trauma. Four previously healthy patients were evaluated for unilateral upper eyelid retraction following periorbital trauma. A 31-year-old man (Case 1) and a 24-year-old man (Case 2) presented with left upper eyelid retraction which developed after blow-out fractures, a 44-year-old woman (Case 3) presented with left upper eyelid retraction secondary to a periorbital contusion that occurred one week prior, and a 56-year-old man (Case 4) presented with left upper eyelid retraction that developed 1 month after a lower canalicular laceration was sustained during a traffic accident. The authors performed a thyroid function test and orbital computed tomography (CT) in all cases. Thyroid function was normal in all patients, CT showed an adhesion of the superior rectus muscle and superior oblique muscle in the first case and diffuse thickening of the superior rectus muscle and levator complex in the third case. CT showed no specific findings in the second or fourth cases. Upper eyelid retraction due to superior complex adhesion can be considered one of the complications of periorbital trauma.